NR 565 - advanced pharmacology midterm - Chamberlain
12 CDC guidelines for prescribing opioids - ANS -Opioids are not first line therapy
establish goals for pain and function
Discuss risks and benefits
Use immediate release opioids when starting
Use the lowest effective dose
Prescribe short durations for acute pain
Evaluate benefits and harms frequently
Use strategies to migrate risk
Review PDMP data
Use urine drug testing
Avoid concurrent opioid and benzo prescribing
Offer treatment for opioid use disorder
\1st line treatment of osteoporosis - ANS -alendronate
\A 41 year old patient comes into the clinic complaining of increased heart rate after starting nitro patches for stable
angina. What would an appropriate response be?
1. lets lower the dose and frequency of use
2. I will prescribe a BB to help with this
3. Next time this happens, lie down and practice deep breathing, this will bring your heart rate down - ANS -2- I will
prescribe a BB to help with this
\A 55 year old male comes into the clinic with a gouty arthritis. He states that he has one flareup a year. Your response is:
1. I will prescribe you glucocorticoids to help with inflammation
2. Lets start you on prophylactic therapy colchicine.
3. It will be helpful to take an NSAID to start with to help relive some inflammation. I'll prescribe naproxen. - ANS -3- in
patients with infrequent flareups, being less than three per year, treatment of symptoms is all thats needed. NSAIDS are
the first line agent for relieving pain of an acute gout attack.
,\A patient comes in stating that he tried NSAIDS to relieve a gouty attack but it hasnt helped. He asks, "what are my
options?" He further states that he has attacks every few years but when he does NSAIDS do not help. Your response is:
1. I can prescribe a glucocorticoid (prednisone) and that will bring down the inflammation and pain.
2. Have your tried increasing your dosage of NSAIDS and drink plenty of water?
3. Lets start by making some changes in your diet, can you tell me what you eat regularly? - ANS -1
3- can also be correct but BEST answer
\A patient with HF develops fibrotic changes, what should the provider do next? - ANS -ensure that a patient is on an ARB
(valsartan) as this inhibits fibrosis (aldosterone antagonist)
\A person who is depend on a pure opioid agonist should NEVER receive an opioid agonist antagonist - ANS -true
\ACE inhibitors MOA - ANS -Angiotensin Converting Enzyme Inhibitors (ACE-I) prevent the conversion of angiotensin I to
angiotensin II, which disrupts the renin-angiotensin-aldosterone system (RAAS).
1. reduce levels of angiotensin II (through inhibition of ACE)
2. increasing levels of bradykinin (through inhibition of kinase 11)
End in -pril
\adverse effects for bisphosphonates - ANS -osteonecrosis of the jaw and hip fracture, Esophagitis
\adverse effects of CCBs in elderly patients - ANS -gingival hyperplasia (overgrowth of gum tissue) and chronic
eczematous rash
\adverse effects of colchicine - ANS -nausea, vomiting, diarrhea, myelosuppression, myopathy, rhabdomyolysis
\adverse effects of digoxin - ANS -GI- anorexia, nausea, vomiting
CNS- fatigue
Visual disturbances **(appearance of halos around dark objects)
dysrhythmias
\Adverse effects of lasix (flurosemide) - ANS -ototoxicity
\adverse effects of nitro - ANS -headache, hypotension, and tachycardia (secondary to vasodilation)
\Adverse effects of opioids - ANS -constipation
urinary retention
orthostatic hypotension
emesis
, neurotoxicity (delirium, agitation)
tolerance and physical dependence
respiratory depression
\adverse effects of pregabalin - ANS -Sedation/drowsy, dizziness, and ataxia, blurred vision, difficulty thinking
\adverse effects of statins - ANS -rhabdomyolysis, hepatoxicity, new-onset diabetes
\After age one what happens to pharmacokinetic parameters, including drug sensitivity? - ANS -mirror adult parameters
\Alendronate patient education - ANS -minimize risk of esophagitis by swallowing the pill whole with a full glass of water,
then sit up for at least 30 min but 60 min preferred. intake of food prevents absorption, take this med 30 min prior to other
intake
\Amiodarone should NOT be taken with what? - ANS -CYP3A4 inhibitors and grapefruit juice (levels can be increased)
\An 82 year old male visits the clinic complaining that his pain medications "take forever" to work after he takes his pill.
What are possible reasons you can explain to him?
1.Perhaps we need to increase your dosage.
2.Sometimes as you get older, absorption may be slower resulting in a delayed response.
3.As we get older the gastric acid decreases and may slow absorption. - ANS -2&3
\ARBS MOA - ANS -Block angiotensin II receptors on blood vessels in heart and adrenals. Increases renal excretion of
sodium and water. Cause dilation of arterioles and veins.
End in -sartan
\Are statins safe in pregnancy? - ANS -No
\Assess someone for possible drug diversion? - ANS -Urine test at least yearly
PDMP routinely
\At what age can statins be prescribed? - ANS -avoid statin use in children under the age of 10
\At what time of day should statins be given and why? - ANS -evening- cholesterol synthesis increases at night
\Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score
What is it? - ANS -ASCVD risk assessment is directed at determining the patient's absolute risk of developing clinical
coronary disease over the next 10 years. Defines high risk as 7.5% or greater.
a calculation of your 10-year risk of having a cardiovascular problem, such as a heart attack or stroke.
\Baseline data for Methotrexate (DMARD) - ANS -chest x-ray, emphasis on pulm and GI status
12 CDC guidelines for prescribing opioids - ANS -Opioids are not first line therapy
establish goals for pain and function
Discuss risks and benefits
Use immediate release opioids when starting
Use the lowest effective dose
Prescribe short durations for acute pain
Evaluate benefits and harms frequently
Use strategies to migrate risk
Review PDMP data
Use urine drug testing
Avoid concurrent opioid and benzo prescribing
Offer treatment for opioid use disorder
\1st line treatment of osteoporosis - ANS -alendronate
\A 41 year old patient comes into the clinic complaining of increased heart rate after starting nitro patches for stable
angina. What would an appropriate response be?
1. lets lower the dose and frequency of use
2. I will prescribe a BB to help with this
3. Next time this happens, lie down and practice deep breathing, this will bring your heart rate down - ANS -2- I will
prescribe a BB to help with this
\A 55 year old male comes into the clinic with a gouty arthritis. He states that he has one flareup a year. Your response is:
1. I will prescribe you glucocorticoids to help with inflammation
2. Lets start you on prophylactic therapy colchicine.
3. It will be helpful to take an NSAID to start with to help relive some inflammation. I'll prescribe naproxen. - ANS -3- in
patients with infrequent flareups, being less than three per year, treatment of symptoms is all thats needed. NSAIDS are
the first line agent for relieving pain of an acute gout attack.
,\A patient comes in stating that he tried NSAIDS to relieve a gouty attack but it hasnt helped. He asks, "what are my
options?" He further states that he has attacks every few years but when he does NSAIDS do not help. Your response is:
1. I can prescribe a glucocorticoid (prednisone) and that will bring down the inflammation and pain.
2. Have your tried increasing your dosage of NSAIDS and drink plenty of water?
3. Lets start by making some changes in your diet, can you tell me what you eat regularly? - ANS -1
3- can also be correct but BEST answer
\A patient with HF develops fibrotic changes, what should the provider do next? - ANS -ensure that a patient is on an ARB
(valsartan) as this inhibits fibrosis (aldosterone antagonist)
\A person who is depend on a pure opioid agonist should NEVER receive an opioid agonist antagonist - ANS -true
\ACE inhibitors MOA - ANS -Angiotensin Converting Enzyme Inhibitors (ACE-I) prevent the conversion of angiotensin I to
angiotensin II, which disrupts the renin-angiotensin-aldosterone system (RAAS).
1. reduce levels of angiotensin II (through inhibition of ACE)
2. increasing levels of bradykinin (through inhibition of kinase 11)
End in -pril
\adverse effects for bisphosphonates - ANS -osteonecrosis of the jaw and hip fracture, Esophagitis
\adverse effects of CCBs in elderly patients - ANS -gingival hyperplasia (overgrowth of gum tissue) and chronic
eczematous rash
\adverse effects of colchicine - ANS -nausea, vomiting, diarrhea, myelosuppression, myopathy, rhabdomyolysis
\adverse effects of digoxin - ANS -GI- anorexia, nausea, vomiting
CNS- fatigue
Visual disturbances **(appearance of halos around dark objects)
dysrhythmias
\Adverse effects of lasix (flurosemide) - ANS -ototoxicity
\adverse effects of nitro - ANS -headache, hypotension, and tachycardia (secondary to vasodilation)
\Adverse effects of opioids - ANS -constipation
urinary retention
orthostatic hypotension
emesis
, neurotoxicity (delirium, agitation)
tolerance and physical dependence
respiratory depression
\adverse effects of pregabalin - ANS -Sedation/drowsy, dizziness, and ataxia, blurred vision, difficulty thinking
\adverse effects of statins - ANS -rhabdomyolysis, hepatoxicity, new-onset diabetes
\After age one what happens to pharmacokinetic parameters, including drug sensitivity? - ANS -mirror adult parameters
\Alendronate patient education - ANS -minimize risk of esophagitis by swallowing the pill whole with a full glass of water,
then sit up for at least 30 min but 60 min preferred. intake of food prevents absorption, take this med 30 min prior to other
intake
\Amiodarone should NOT be taken with what? - ANS -CYP3A4 inhibitors and grapefruit juice (levels can be increased)
\An 82 year old male visits the clinic complaining that his pain medications "take forever" to work after he takes his pill.
What are possible reasons you can explain to him?
1.Perhaps we need to increase your dosage.
2.Sometimes as you get older, absorption may be slower resulting in a delayed response.
3.As we get older the gastric acid decreases and may slow absorption. - ANS -2&3
\ARBS MOA - ANS -Block angiotensin II receptors on blood vessels in heart and adrenals. Increases renal excretion of
sodium and water. Cause dilation of arterioles and veins.
End in -sartan
\Are statins safe in pregnancy? - ANS -No
\Assess someone for possible drug diversion? - ANS -Urine test at least yearly
PDMP routinely
\At what age can statins be prescribed? - ANS -avoid statin use in children under the age of 10
\At what time of day should statins be given and why? - ANS -evening- cholesterol synthesis increases at night
\Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score
What is it? - ANS -ASCVD risk assessment is directed at determining the patient's absolute risk of developing clinical
coronary disease over the next 10 years. Defines high risk as 7.5% or greater.
a calculation of your 10-year risk of having a cardiovascular problem, such as a heart attack or stroke.
\Baseline data for Methotrexate (DMARD) - ANS -chest x-ray, emphasis on pulm and GI status
